With at least one care home across Scotland closing each week, the Royal College of Physicians of Edinburgh is urging the Scottish government to ensure the sector is supported and sustained over the winter.

Scottish Care has warned that Scotland has witnessed the largest number of care home closures ever experienced over the last few months, with a lack of extra national funding likely to place even more at risk.

The Royal College of Physicians of Edinburgh (the College) is now calling for all stakeholders to get round the table to discuss solutions.

The College says the reduction in care home capacity intensifes delayed discharges from hospitals, especially over the winter where demand is highest.

Delayed discharge levels remain at a historic high: in the year ending 31 March 2023, the worst annual figure on record was revealsed with 661,705 days spent in hospital by people whose discharge was delayed.

Delays not only affect patient flow through hospitals but, the College explains, are also detrimental to the welfare of patients and their families.

Professor Andrew Elder, President of the College, highlights the need for care homes to remain open – both for the long term care needs of Scots and to support hospitals:

“The College is deeply concerned that care homes in Scotland are closing at the rate of one every week. Care homes not only provide long term care for older people but often act as a bridge from hospital to home.

“A major cause of the flow difficulties experienced in acute care in recent years has been “exit block” – the difficulty in supporting patients back to their homes after hospitalisation.

“Capacity in care homes is already stretched and any further reduction will not only have an impact on the NHS Scotland’s ability to provide safe and effective care in its acute wards but will impact on the dignity and welfare of those patients who are delayed and have to wait inappropriately for weeks or months in hospital wards.”

An NHS hospital pharmacist told healthandcare.scot earlier this year that the workforce crisis has left hospitals working near or at capacity – sometimes “just fighting fires and doing the discharge”.

Earlier this year, as hospices called for support through the fuel crisis, Miles Briggs MSP told healthandcare.scot that both the UK and Scottish governments need to come together.

He said they must look at the rising pressures across hospitals, care homes, carers and hospices ahead of this winter to find a solution for the whole care sector.

Now, the Royal College of Physicians of Edinburgh is urging the Scottish government to look at “all possible actions” to support care homes to operate sustainably.

Professor Elder adds that a whole system approach to supporting demand and providing care is urgently needed. He says this must include protecting care home capacity and tackling the workforce crisis:

“The impact of a decline in care home capacity is felt across the whole system – contributing to longer waits in emergency medicine and a decline in bed availability for elective surgery in hospital wards.

“Capacity issues are year-round in the Scottish NHS at this time – the winter months only see the situation worsen, hence our warning now, that care home capacity must be protected in the coming months. 

“We urge the Scottish government and local government stakeholders, as a matter of urgency, to get round the table with the independent care sector and explore all options to support it and help make it sustainable, not least in terms of tackling its very severe workforce challenges.

“We need to have a successful care home sector for both the people who require places within it and for the effective functioning of our NHS as a whole.”

Read more: Hospice chiefs: “Let's discuss fair funding”; College: Preserve GPs to preserve the NHS; Auditor General: Difficult choices for Scotland's NHS; RCN: Staff need to see light at the end of the tunnel

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